Efficacy and safety of prophylactic simultaneous intravitreal moxifloxacin injection with standard intravitreal anti-VEGF injection procedure in cases of cystoid macular edema and macular neovascularization

Abstract

Background: To investigate the safety and efficacy of prophylactic use of commercially available intravitreal moxifloxacin 0.5% (Vigamox) at the time of intravitreal anti-VEGF injection against post-injection infectious endophthalmitis. Patients and Methods: A prospective interventional randomized controlled trial including eyes with cystoid macular edema or macular neovascularization planned to receive intravitreal anti-VEGF therapy. Eyes were randomly assigned to either day A or day B for intravitreal injection procedure; eyes in day A received simultaneous intravitreal anti-VEGF and moxifloxacin (study group), while eyes in day B received intravitreal anti-VEGF only (control group). The presence of postoperative toxic reactions and endophthalmitis rates was assessed together with change in BCVA & retinal in both groups. Results: A total of 1352 intravitreal injection procedures were done in study group and 1487 in control group. Endophthalmitis was rare across both groups, 0 case in the study group and two cases (0.2%) in the control group which was statistically insignificant (P = 0.502). Reduction in CME was comparable in both groups, (MD = -228.17 μm) in the study group, (MD = -221.28 μm) in the control group (P = 0.044). Similar Improvement of BCVA in both groups with a difference of -0.56 in the study group and − 0.54 in the control group (P = 0.151). No toxic AC reactions or retinal toxicity was observed in the study group confirmed by similar postoperative ellipsoid zone/external limiting membrane (EZ/ELM) improvement compared to control group, 37.0% and 27.0% respectively. Conclusion: Simultaneous intravitreal injection of moxifloxacin during intravitreal anti-VEGF procedure is safe and effective measure to be added to the armamentarium of prophylaxis against post injection endophthalmitis.